title: Central line-associated bloodstream infection in neonatal intensive care units.
abstract: OBJECTIVE
  Describe the epidemiology of central line-associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) participating in a standardized and mandatory CLABSI surveillance program.
  
  
  METHODS
  Retrospective cohort. Setting. We included patients admitted (April 2007-March 2011) to 7 level II/III NICUs who developed a CLABSI (as defined by the National Healthcare Safety Network).
  
  
  METHODS
  CLABSIs/1,000 central line-days and device utilization ratio were calculated; χ(2) test, Student t test, Kruskal-Wallis, and Poisson regression were used.
  
  
  RESULTS
  Overall, 191 patients had 202 CLABSI episodes for a pooled mean rate of 4.0 CLABSIs/1,000 central line-days and a device utilization ratio of 0.20. Annual pooled mean CLABSI rates increased from 3.6 in 2007-2008 to 5.1 CLABSIs/1,000 central line-days in 2010-2011 (P - .01). The all-cause 30-day case fatality proportion was 8.9% (n = 17) and occurred a median of 8 days after CLABSI. Coagulase-negative Staphylococcus was identified in 112 (50.5%) cases. Staphylococcus aureus was identified in 22 cases, and 3 (13.6%) were resistant to methicillin. An underlying intra-abdominal pathology was found in 20% (40/202) of CLABSI cases, 50% of which were reported in the last year of study. When adjusted for mean birth weight, annual CLABSI incidence rates were independently associated with the proportion of intra-abdominal pathology (P = .007) and the proportion of pulmonary pathology (P = .016) reported.
  
  
  CONCLUSIONS
  The increase in CLABSI rates in Quebec NICUs seems to be associated with an increased proportion of cases with underlying intra-abdominal and pulmonary pathologies, which needs further investigation.
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Blanchard
authors.forename: Elise
authors.initials: E
authors.lastname: Fortin
authors.forename: Isabelle
authors.initials: I
authors.lastname: Rocher
authors.forename: Dorothy L
authors.initials: DL
authors.lastname: Moore
authors.forename: Charles
authors.initials: C
authors.lastname: Frenette
authors.forename: Claude
authors.initials: C
authors.lastname: Tremblay
authors.forename: Caroline
authors.initials: C
authors.lastname: Quach
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D001724:Birth Weight; D058387:Candidemia / Q000453:epidemiology; D002177:Candidiasis / Q000453:epidemiology; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects / Q000382:microbiology; D015897:Comorbidity; D004927:Escherichia coli Infections / Q000453:epidemiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D007710:Klebsiella Infections / Q000453:epidemiology; D008171:Lung Diseases / Q000453:epidemiology*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology